Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal.
Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Int J Impot Res. 2023 Aug;35(5):454-459. doi: 10.1038/s41443-022-00565-5. Epub 2022 Mar 28.
Although male hypogonadism (MH) is a prevalent comorbidity in patients presenting for erectile dysfunction (ED), its screening relies solely on total testosterone (TT). Ageing and other conditions can increase sex hormone-binding globulin (SHBG) and lower free testosterone (FT) causing symptomatic MH despite normal TT. The primary objective was to measure the prevalence of normal TT/low FT among patients presenting for ED. From January 2019 to December 2020, 408 patients referred for sexual dysfunction were screened; 180 men with a confirmed diagnosis of ED were included. MH was screened using TT, SHBG, albumin and LH. FT was calculated (cFT). Low TT, high SHBG and low cFT were defined as <345 ng/dL, >50 nmol/L and <6.5 ng/dL, respectively. Patients were divided into groups according to TT/cFT status and to age group. The frequency of normal TT/low cFT was 17.2%. From all 31 patients with normal TT/low cFT, only four (12.9%) had either hyperthyroidism, hepatic disease or HIV infection, while 23 (74.2%) were older than 60 years. Patients with normal TT/low cFT were older (65.57 ± 10.43 vs. 56.79 ± 10.63 yo, p = 0.001) and had higher SHBG (78.48 ± 40.14 vs. 52.35 ± 20.39 nmol/L, p = 0.014) than patients with normal TT/cFT. Patients over 60 years represented 48.9% of the sample, 52.5% had elevated SHBG and their frequency of normal TT/low cFT was 26.3%. Normal TT/low cFT is frequent and can be missed by current screening recommendations for MH in patients presenting for ED. Ageing seems to be the main culprit as elevated SHBG prevalence increases steeply after the sixth decade. TT cannot solely be relied on to exclude biochemical MH in patients presenting for ED, especially in patients over 60 years old. Current guidelines for MH screening in ED should be amended.
尽管男性性腺功能减退症（MH）是勃起功能障碍（ED）患者常见的合并症，但它的筛查仅依赖于总睾酮（TT）。随着年龄的增长和其他一些情况，性激素结合球蛋白（SHBG）会增加，游离睾酮（FT）会降低，导致尽管 TT 正常但仍出现有症状的 MH。主要目的是测量因 ED 就诊的患者中 TT 正常/FT 降低的患病率。从 2019 年 1 月至 2020 年 12 月，对 408 名因性功能障碍就诊的患者进行了筛查；其中 180 名男性被确诊为 ED。使用 TT、SHBG、白蛋白和 LH 筛查 MH。计算 FT（cFT）。低 TT、高 SHBG 和低 cFT 的定义分别为 <345ng/dL、>50nmol/L 和 <6.5ng/dL。根据 TT/cFT 状态和年龄组将患者分为不同的组。TT 正常/FT 降低的频率为 17.2%。在所有 31 名 TT 正常/FT 降低的患者中，仅有 4 名（12.9%）患有甲状腺功能亢进症、肝脏疾病或 HIV 感染，而 23 名（74.2%）年龄大于 60 岁。TT 正常/FT 降低的患者年龄更大（65.57±10.43 岁 vs. 56.79±10.63 岁，p=0.001），SHBG 更高（78.48±40.14 vs. 52.35±20.39nmol/L，p=0.014）。60 岁以上的患者占样本的 48.9%，52.5%的患者 SHBG 升高，他们 TT 正常/FT 降低的频率为 26.3%。TT 不能单独用于排除因 ED 就诊的患者的生化 MH，尤其是年龄大于 60 岁的患者。目前 ED 中 MH 筛查的指南应该进行修订。
